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Burnett County 7410 Co. I d. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLI ATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit tOf the work described and <br /> located as shown herein. The u idersigned agrees that all work shall be done in accordance with the requirements of the u W <br /> Burnett County Land Use Ordini nce,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisc nsin. y m <br /> m O <br /> OWNERepi5tC.E TELEPHONE r//Jr"_ l�a,y_3LfZ m <br /> ADDRESS <br /> rF13 <br /> t <br /> EMERGENCY/FIRE NUMBER ROAD NAME ,C LL/c°T Tv <br /> <o r r GS in, V y, r09sr /57 y'- t /95'. F�✓ Y LoT <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/3UILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O 1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> J — <br /> m � <br /> STRUCTUREJADDITION USE: <br /> (Home/Cabin;Co ercial Business; Bedroom;Deck;etc.) Z <br /> o <br /> DIRECTIONS FOR PLOT PLAI I DRAWING: (Aerial or top view) } <br /> 1. Show the location and sIzE of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of thew 211 (W),septic tank (ST),and drainf laid (DIF). o <br /> 3. Show dimensions in feet of I he following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinai y high water mark of lake,stream,or river. <br /> 4. K separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 'I o m <br /> PLOT PLANZ c <br /> SLA<L / - 5ro u rvLtr ss NOJf6D A o n <br /> Ip /20eC m 9 0 <br /> /SsPr C <br /> m � s <br /> S2l <br /> 9J s <br /> rn <br /> 332 . 9/ C� 0 <br /> o' <br /> J <br /> O <br /> J <br /> [1• •t7 J <br /> N <br /> paoP�sao r o <br /> WIi N- • <br /> N <br /> •30 3% o <br /> 8 Ptab k <br /> Z <br /> PIC)V)01 ) <br /> -- -- -- • a <br /> ?J2ivis <br /> to <br /> m sot-UV >> <br /> n 2. Li m <br /> m. D$� ane <br /> CONDITIONS OF PERMIT: Q $ gm S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m' <br /> J <br /> 2. REMOVAL OR CUTTING o E F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N ` 6 2 a D <br /> I declare that this application(i icluding any accompanying schedule)has been examined by me and to the best of my knowl- o l t <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- N y m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i i B p <br /> mation I am providing will be i elled upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability whict may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have i i <br /> C-a m <br /> access to the above described premises at any reasonable time for the purpose of inspection. 9 <br /> SIGN HERlY i � `o <br /> -T : <br /> (ailInati7r owner or riding contractor) (date) <br /> ZONING ADMINISTRATOR i <br /> TOWNSHIP PERMITS MAY BE REOUI Ct1, ` i1 o witaw <br /> N N m <br /> , "A $ os $ y <br /> 0 <br />